Terry M. Pace

PSYCHOLOGICAL CONSULTATION WITH PRIMARY CARE PHYSICIANS : OBSTACLES AND OPPORTUNITIES IN THE MEDICAL SETTING

This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted. Primary practice and the role of the primary care physician will likely assume increasing importance as health care reform proceeds through the 1990s and into the 21 st century. Likewise, because psychologists have assumed fundamental research, clinical servke, and training roles in primary health care settings, it can be anticipated that these roles will become paramount in shaping the delivery of primary care services in the future. As evidence of the growing interest in this topic, the American Psychological Association (APA) recently sponsored

Training Models in Counseling Psychology Scientist-Practitioner Versus Practitioner-Scholar

Considerable discussion has occurred through the years regarding models of training. With the recent accreditation of counseling psychology programs espousing the practitioner-scholar model, the importance of reexamining the merits of this as well as the traditional scientist-practitioner is now very important for the future of the field. This article consists of two positions: One pro practitioner-scholar and the other pro scientist-practitioner and con practitioner-scholar. The first position (first part of the article) by Biever, Patterson, and Welch argues for inclusion of the practitioner-scholar model as an alternative for training in counseling psychology. The second position (in the second part of the article) by Stoltenberg, Pace, and Kashubeck reviews concerns with two competing models. These authors conclude that the scientist-practitioner model is a better fit for training in counseling psychology. Recommendations for training within models are presented.

Screening for Depression in Primary Care Patients: Dimensionality of the Short Form of the Beck Depression Inventory

In an attempt to discover factors that might explain the high misclassification rate of the short form of the Beck Depression Inventory (BDI) as a screening tool for depression in primary health care patients (primarily due to false positives), confirmatory factor analysis was used to test the dimensionality of the instrument with data from a sample of 598 family practice outpatients. A dual-factor specification provided a superior fit, with two moderately correlated factors (r =.722), identified and labeled Nonsomatic Symptoms and Somatic Symptoms. The items work inhibition and Fatigue loaded together on the Somatic Symptoms factor, whereas the anorexia item loaded on both factors, and it is hypothesized that these symptoms are elevated in otherwise nondepressed, medically ill patients

Decolonizing personality assessment and honoring indigenous voices: a critical examination of the MMPI-2.

Utilizing a mixed methods approach located between constructivist-interpretivist and critical-ideological research paradigms (Ponterotto, 2005), the current study builds upon previous research (Pace et al., 2006) that investigated the cultural validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 in its use with American Indians. Thirty items from MMPI-2 scales F, 1, 6, 8, and 9 were identified via item analysis as reflecting significant differences in endorsement rates between an American Indian sample and the MMPI-2 normative group. Semistructured interviews focused on these 30 items were conducted with 13 American Indian participants from an Eastern Woodlands Nation in Oklahoma. Interviews were audio recorded, transcribed, and then coded for themes using a qualitative coding analysis. Nine themes emerged: core belief system, experiences of racism and discrimination, conflicting epistemologies, living in two worlds, community connectedness, responsibility and accountability to the community, traditional knowledge, stories as traditional knowledge, and language and historic loss. Results of the current study demonstrate how the MMPI-2 may pathologize Indigenous worldviews, knowledge, beliefs, and behaviors rather than accurately assess psychopathology. Implications for practice and future research are addressed.

A cultural-contextual perspective on the validity of the MMPI-2 with American Indians.

This study investigated the normative validity of the MMPI-2 with two distinct American Indian tribes. Differences occurred on 8 of the 13 basic validity and clinical scales (F, 1, 4, 5, 6, 7, 8, 9) between the MMPI-2 norms and both tribal samples. Elevated MMPI-2 scores of American Indians may not only reflect the possibility of psychological distress spurred by historical oppression and present adversity, but also an expression of a divergent worldview. Considering the context of the historical and social production of knowledge about American Indians, it is argued that researchers and practitioners, when interpreting MMPI-2 results for American Indians, should seriously consider their interpretive points of reference, which may be impacted by dominant cultural belief systems.

A Psychometric Comparison of the Beck Depression Inventory and the Inventory for Diagnosing Depression in a College Population

The relationship between the Beck Depression Inventory (BDI) and the Inventory for Diagnosing Depression (IDD) was evaluated in a college population. The BDI is an established self-report depression instrument. The IDD is a relatively new self-report depression instrument. The IDD was designed to address the BDIs lack of full correspondence with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) (DSM-III) through DSM-IV criteria. The two instruments were found to be highly correlated and Cronbachs alpha was found to be high for each instrument. The diagnostic performance of three BDI cutoff scores was found to vary considerably when compared to IDD diagnostic criteria. Implications for selection and use of self-report depression inventories are discussed.

Culturally Competent Use of the Minnesota Multiphasic Personality Inventory-2

Publisher Summary This chapter examines the use of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) with ethnic minorities in the United States, including Puerto Rico. It also presents case studies to illustrate the progress being made in culturally competent assessment of ethnic minorities. Discussion provides an answer to a series of questions regarding the MMPI-2 and its application to minority populations. These questions are frequently posed by both researchers and clinicians who consider using this instrument in the evaluation of minority group members. Primarily it attempts to answer questions related to the extent to which the MMPI-2 been applied to ethnic minorities. It also discusses the trends or patterns of MMPI-2 research with minorities and the types of research still need to be conducted with the MMPI-2. In addition, it discusses six case studies that illustrate culturally competent approaches to MMPI-2 use and interpretation. In order to continue progress, researchers and clinicians alike are encouraged to reexamine their standards of practice when using and interpreting standardized measures with ethnic minorities. An understanding of within- and between-group differences is necessary to provide a frame of reference for culturally competent interpretation of MMPI-2 profiles with ethnic minorities. Likewise, sociocultural and environmental factors should always be considered before psychopathology is attributed to a client on the basis of an elevated MMPI-2 scale.

Adjusting to New Places: International Student Adjustment and Place Attachment

Using data obtained from in-depth semistructured interviews, we examined international students’ attachments to place in the local American Midwestern community where they have attended college for at least 2 years. The results of this study suggest that participants engage in a process of renegotiation of meanings attached to new places in ways that fulfill specific needs, such as a desire for social interaction, an opportunity for self-expression, and the expression of their emotional experience. The implications of the study results contribute to understanding the role of place attachments in the process of adjustment to another culture, as places seem to be evaluated and redefined so that they are experienced in congruence with the self.